HomeMy WebLinkAbout247960 07/28/15 - CITY OF CARMEL, INDIANA VENDOR: 368794
!; ® ONE CIVIC SQUARE APRIL MURRAY CHECK AMOUNT: S**......13.23*
x ?4 CARMEL, INDIANA 46032 C/O LAW CHECK NUMBER: 247960
'M;ro CHECK DATE: 07/28/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4343004 13.23 TRAVEL PER DIEMS
rrescno—uy mace tsoard of Accounts General Form No.101 (1955)
MILEAGE CLAIM
City of Carmel, Indiana TOS 1 1 ` 1 Y 4 uffq'A DR.
(Governmental Unit)
De -menof Law - 1180 On Account of Appropriation No. 434-3004. for Mileage
Office, Board,Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE @ 6-7,�]
20—L5= Point Point Start Finish TRAVELED PER MILE
71 15 Lc'f r \ ( al 1 � / a
J
Auto License No. TOTALS 13 3
* SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
i
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due,after
allowing all just credits, and that no part of the same has been paid.
Date
Cladm No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as rewired
by law;
That it is based upon statutory authority;
9 That it is apparently correct
$ ! incorrect
On Account of Appropriation No.4343004 _for
Disbursing Officer
Department of Law - 1180
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